Provider Demographics
NPI:1083630677
Name:BAEK, HUSEK H (MD)
Entity type:Individual
Prefix:
First Name:HUSEK
Middle Name:H
Last Name:BAEK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 444 BOX 94
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96297-0001
Mailing Address - Country:US
Mailing Address - Phone:821-073-5818
Mailing Address - Fax:
Practice Address - Street 1:OPC 371
Practice Address - Street 2:BOX 39
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271-9001
Practice Address - Country:US
Practice Address - Phone:315-737-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A779920Medicaid
00A779921Medicare ID - Type Unspecified
CA00A779920Medicaid